Intraoperative Management of Patients with Pulmonary Hypertension

Christopher W. Connor, MD, PhD Assistant Professor of Anesthesiology and Biomedical Engineering Department of Anesthesiology Boston University School of Medicine Boston, MA Patients with pulmonary hypertension are some of the most challenging for an anesthesiologist to manage. Pulmonary hypertension in patients undergoing surgical procedures is associated with high morbidity and mortality due to right ventricular failure, arrhythmias and ischemia leading to hemodynamic instability, and intraand postoperative hypoxia. Considering the challenges that these patients pose in the perioperative period, it is critical for anesthesiologists, surgeons, and other physicians who care for these patients to be well versed in managing pulmonary hypertension. The purpose of this article is to review the anesthetic considerations that pertain to patients with pulmonary hypertension in the perioperative period, with particular emphasis on the choice of anesthesia, the relative risks of moderate sedation and general anesthesia, and the most recent intraoperative monitoring recommendations.